Gov. Rick Scott says he will expand Medicaid in Florida. (Photo by Gage Skidmore.)
By Ashley Lopez
Florida Center for Investigative Reporting
Rick Scott was one of the most ardent opponents of 2010’s health care reform law. But now, as Florida’s governor, Scott has agreed to enact one of the key, and voluntary, provisions of the law — to expand Medicaid to thousands of poor Floridians who lack health care coverage.
The federal government will foot the entire bill for the first few years of this expansion, which means this sudden announcement won’t affect the state budget Scott recently released.
Scott is one of the most prominent Republican governors to agree to the expansion. So far, his Republican counterparts in Pennsylvania and Wisconsin have turned down the money.
Scott began his political career in 2009 with a campaign to stop the proposed health care reform law. He has been fighting the law ever since. The state of Florida even spent a hefty amount of cash fighting the constitutionality of the law in the U.S. Supreme Court. In short, few have fought the existence of the Affordable Care Act as ardently as Scott.
Because Florida is a populous state with one of the highest rates of uninsured in the country, having the Sunshine State agree to the expansion represents a victory for the Obama administration.
But there is a catch to Scott’s capitulation.
Mr. Scott said Wednesday that he now supported a three-year expansion of Medicaid, through the period that the federal government has agreed to pay the full cost of the expansion, and before some of the costs are shifted to the states.
“While the federal government is committed to paying 100 percent of the cost, I cannot in good conscience deny Floridians that needed access to health care,” Mr. Scott said at a news conference. “We will support a three-year expansion of the Medicaid program under the new health care law as long as the federal government meets their commitment to pay 100 percent of the cost during that time.”
He said there were “no perfect options” when it came to the Medicaid expansion. “To be clear: our options are either having Floridians pay to fund this program in other states while denying health care to our citizens,” he said, “or using federal funding to help some of the poorest in our state with the Medicaid program as we explore other health care reforms.”
As many suspected, Scott’s agreement to expand the program came only if the federal government also agreed to approve Florida’s controversial Medicaid privatization. According to the Times,”shortly before his announcement, the governor received word from the federal government that it planned to grant Florida the final waiver needed to privatize Medicaid, a process the state initially undertook as a pilot project.”
Hospitals and advocates for the poor have been pushing the state to accept the Medicaid expansion for moral and fiscal reasons. However, economists have said the real drawback would be the state’s rejection of millions in federal money by choosing not to expand Medicaid.
His flip-flop Wednesday shows how difficult it will be for governors to hold out on ideological grounds when the financial incentives to switch are so significant. According to a recent Urban Institute analysis, Florida will get about $66 billion in federal dollars over 10 years if it expands, and will spend about $5 billion. (Scott has not committed to a full 10 years of expansion, which makes the deal potentially better, since the federal government will pick up 100 percent of the tab in those early years.) About 1.3 million low-income uninsured Floridians would get coverage over 10 years, according to the Urban numbers.
“While the federal government is committed to paying 100 percent of the cost of new people in Medicaid, I cannot, in good conscience, deny the uninsured access to care,” Scott said on Wednesday, calling his choice a “compassionate, common-sense” decision.
The Times also reports that Scott said “the state would not create its own insurance exchange to comply with another provision of the law.”
This means the federal government is going to step in and create a state-based health insurance market in lieu of the state, as required by law.